SRUTHI SAMALA DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****07

License Status

ACTIVE

Business

Title

First Name

SRUTHI

Last Name

SAMALA

Business Name

SRUTHI SAMALA DO

Original Issue Date

03/22/2022

Effective Date

04/09/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61637

County

PEORIA

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/09/2023